"The worst affected area is Mthatha in the OR Tambo region where health centres are clogged. Boys are brought in with their penises practically falling off," Kupelo said.

The already constrained health system in the province was suffering a setback because of the initiation season.

"The day to day work by health workers is severely affected, the department is spending R1000 on each initiate brought in for treatment," said Kupelo.

The department had set aside R20 million to intervene and help the initiates.

Private healthcare services and an additional 37 SUV vehicles have been hired to get health workers to initiates in the mountains.

The parents of the initiates were to blame for some of the problems experienced, he said.

Parents allowed criminals masquerading as circumcision experts to circumcise their children. The parents also denied health workers access so they could examine the boys, Kupelo said.

"In one instance, a young boy died a day after his father refused him access to a health worker. That parent must be held accountable."

Kupelo said the department urged police and the National Prosecuting Authority to bring criminal charges against the perpetrators.

The Mthatha area had seen criminals "milking" the custom to their advantage while putting the lives of young boys at risk.

"We want law enforcement to charge them with murder wherever a life is lost. These criminals use the same instrument on all boys, increasing the risk of contracting HIV/Aids and other diseases. The initiates are very young and their lives are in danger on a daily basis," he said.